This article explores the evolution of US policy on Antarctica, focusing on its legal, environmental and geopolitical aspects. It aims to identify changing US priorities in this regard. The Antarctic Treaty System (ATS) governs the region, emphasizing peace, scientific cooperation and environmental protection. The USA has issued four major memoranda on Antarctica in 1982, 1994, 2020 and 2024. This article highlights growing geopolitical competition, particularly with China and Russia. China frames Antarctica as essential to its global rise, using dual-purpose technologies that blur the line between science and strategic military interests. Similarly, Russia’s activities in the region raise concerns about potential violations of the ATS’s peaceful purpose mandate. The USA maintains its leadership in Antarctic diplomacy, advocating for environmental preservation and scientific cooperation. This article concludes by emphasizing the need for international collaboration to address climate change, resource exploitation and rising strategic tensions, ensuring Antarctica remains a region dedicated to peace and science.

Non-nutritive sweeteners (NNSs) are popular sugar substitutes, valued for their potential to reduce caloric intake and associated health risks. However, their long-term effects on the human gut microbiome remain debatable. This study investigates the impact of tagatose, allulose, Rebaudioside-A (Reb-A), and saccharin on quorum-sensing (QS)-regulated phenotypes and gene expression in QS biosensor model bacteria. It sheds light on their potential influence on the gut microbiome. Our study revealed diverse effects among the NNSs. Tagatose and allulose demonstrated QS phenotypic inhibition in Chromobacterium violaceum (≈50%) and Pseudomonas aeruginosa (20–50%) in a concentration-dependent manner. Additionally, tagatose and allulose decreased the P. aeruginosa lasI gene expression. Reb-A and saccharin presented a significant, however less prominent, phenotypic inhibition on C. violaceum (25–30%) and P. aeruginosa swarming motility (≈20%). Both NNSs decreased the expression of the lasI gene of P. aeruginosa. Molecular docking of QS regulatory proteins showed that saccharin and Reb-A have significantly higher binding affinity compared to allulose and tagatose, relative to native inducers. These results suggest the complex interactions mediated by NNSs in QS regulatory pathways. These findings provide valuable insights into the varied, species and dose-dependent effects of NNS on microbial communication, suggesting potential implications for the gut microbiome.

Objectives: Six types of chemical indicators (CIs) are specified in ISO11140-1 for monitoring steam sterilization processes (SSP). Types3-6 are “internal” CIs, placed inside packs to assess attainment of sterilizing conditions. Type4 CIs have an ink patch which changes colour during the SSP. Type5 CIs exist as an ink patch which changes colour or a “moving front” (MF) format where a dye migrates along a wick reaching a pass/fail marker point. This study compares the requirements for type4 versus type5 CIs according to ISO11140-1, evaluates the claims of some type4 and 5 CIs with regard SSP parameters, and tests the ability of type5 CIs to meet specified performance and variability of response. Methods: We reviewed ISO requirements and stated commercial claims of type4 and 5 CIs. Samples of several Type5 CIs were exposed to increasing times at a temperature of 121oC in a CI Evaluating Resistometer. Upon completion of the test cycle samples were removed and the length of the ink migration measured and charted. Results and Conclusions: According to ISO11140-1 requirements, Type4 CIs need not respond to all SSP variables. Type4 CIs can have stated values (SV) which are unrelated to SSP parameters used. The tolerances for the pass/fail window for a Type5 CI is better than for a Type4. The performance of a Type5 CI has a relationship to that of a biological indicator (BI). The performance requirements for Type5 CIs are more prescriptive. MF- CIs provide greater clarity for interpretation compared to the colour change of some CIs. The SVs and colour change of type4 CIs are specified by the manufacturer. The minimum SVs for Type5 CIs are prescribed in ISO11140-1. When tested, there was considerable variation in the response of some Type5 MF-CIs; a factor not addressed in ISO11140-1.

This research introduces a cutting-edge approach to glucose monitoring, which is essential in many applications. The study developed a new non-invasive glucose monitoring system utilizing machine learning techniques. This system examines the reflection coefficient data gathered from glucose solutions using a Vector Network Analyzer. To showcase the system’s accuracy in predicting glucose levels, two distinct datasets were employed. The first dataset comprised glucose solutions with concentrations spanning from 0 to 200 g/L, while the second dataset included solutions ranging from 15 000 to 20 000 mg/L for enhanced precision. The system measured both datasets, and three machine learning algorithms – Decision Tree, Random Forest, and Support Vector Regression – were applied to the collected data. Furthermore, a grid search method was employed to optimize the hyperparameters for each model’s optimal performance. The findings revealed that the Random Forest yielded the best results across both datasets. For gram scale, the R2 value was 0.9995, indicating that 99.95% of the glucose level variance was accounted for, with a low RMSE of 1.1589 mg/dL. Moreover, in milligram scale dataset, the R2 value was 0.9932, and RMSE was 1.1119 mg/dL, confirming the model’s high accuracy. These experimental outcomes demonstrate that the proposed system can effectively predict glucose levels.

This study examined the role of coping resources – self-efficacy (problem-focused) and emotion regulation (emotion-focused) – in supporting mental health and social functioning among refugees in a transit setting in Indonesia. Using a latent profile analysis approach with 1,214 participants, three distinct coping profiles were identified: high coping resources, high emotion-focused coping resource, and low coping resources. Results showed that high coping resources were associated with better mental health and social functioning outcomes. Emotion-focused coping resources were more strongly associated with better mental health, while problem-focused coping resources were closely linked to social functioning. This study highlighted the importance of coping flexibility and offers practical implications for strength-based interventions in transit displacement settings.

Background: The adult intensive care unit comprises a total of 18 beds. On October 18, 2023, a text notification alerted us to a patient whose wound culture tested positive for Enterococcus faecium (VRE). Following protocol, an Anus VRE screening was conducted on the adjacent bed, revealing three additional positive cases, suggesting a cluster outbreak. Investigation and management were initiated. Methods: Through interviews, observations, medical record reviews, and expanded VRE screenings, a total of 8 beds tested positive, resulting in a positivity rate of 44.4% (8/18), all cases being colonization. Root cause analysis identified failures in hand hygiene among healthcare workers (HCWs), failure to wash hands before donning gloves, incorrect sequencing of environmental cleaning and disinfection, and inadequate implementation of contact isolation precautions. Measures included conducting Anus VRE screening for ICU admissions from October 15th to 18th, increasing the frequency of unit cleaning and disinfection, providing education and training, auditing hand hygiene practices and isolation measures, and centralizing VRE patient care. Results: Utilization of multiple measures for controlling drug-resistant bacterial infections, including auditing hand hygiene, environmental cleaning and disinfection, implementing contact isolation precautions, and conducting environmental sampling, yielded negative results. Observation until November 30th showed no new cases, effectively controlling the spread of drug-resistant bacteria and preventing healthcare-associated infections due to VRE. Discussion: Despite HCWs’ often busy clinical care responsibilities leading to neglect of hand hygiene or substituting handwashing with glove usage, and lapses in implementing contact isolation precautions, no healthcare-associated infections occurred, and patients were successfully discharged without disease exacerbation or fatalities. Environmental sampling was conducted post-environmental disinfection. Additionally, all VRE-positive patients were identified as Enterococcus faecium (VRE). Due to limitations, PFGE testing couldn’t be conducted, hence strain and susceptibility determination confirmed the same VRE colonization event within the hospital.

Objectives: Chronic wounds are commonly manifested with biofilms that result in delayed healing and recurring infection episodes. Due to increasing antimicrobial resistance, antiseptics have played a significant role in wound infection management. To date, there is no standardised method to assess the ‘true’ antimicrobial efficacy of different antimicrobials, especially in testing condition that stipulate a high protein environment in the wound. As clinicians often rely on the antimicrobial efficacy profiles for product selection, a rigorous testing is warranted. Hypochlorous acid (HOCl)-based solutions have been introduced as a good alternative for wound cleansing but the assessment of its antimicrobial activities in a stipulate wound environment is limited. In this study, we assessed the in vitro bactericidal activities of 7 commercially available wound irrigation products commonly found in South-East Asia. Method: The evaluation was conducted using quantitative suspension method, EN 13727 in either low or high protein conditions. Results: Under low protein conditions, four out of the five HOCl products achieved bactericidal activity (≥ 5 log10 reduction factor; RF) within 2 to 5 minutes, and only one product achieved 5 log RF at 15 seconds. None of the HOCl achieved 5 log RF under high protein, even after 30 minutes of exposure time. In contrast, protein interference on the antimicrobial activities of polyhexamethylene biguanide-based product is less pronounced (low protein: 60 seconds vs. high protein: 2 minutes to attain ≥ 5 log RF). Octenidine dihydrochloride is the only active not affected by protein interference achieving ≥ 5 log10 RF within 15 seconds in both low and high protein conditions. Conclusion: These findings warrant the need to screen antimicrobial wound care products, especially HOCl-based products, in high protein condition to better reflect the antimicrobial activities in wound care.

Selecting appropriate texts for second language (L2) learners is essential for effective education. However, current text difficulty models often inadequately classify materials for L2 learners by proficiency levels. This study addresses this deficiency by employing the Common European Framework of Reference for Languages (CEFR) as its foundational framework. A cohort of expert English-L2 educators classified 1,181 texts from the CommonLit Ease of Readability corpus into CEFR levels. A random forest model was then trained using 24 linguistic complexity features to predict the CEFR levels of English texts for L2 learners. The model achieved 62.6% exact-level accuracy across the six granular CEFR levels and 82.6% across the three overarching levels, outperforming a baseline model based on three existing readability formulas. Additionally, it identified shared and unique linguistic features across different CEFR levels, highlighting the necessity to adjust text classification models to accommodate the distinct linguistic profiles of low- and high-proficiency readers.

Introduction: To avoid Clostridium difficile infection in the healthcare facility is an important work. There were many methods to do in the C. difficile infection (CDI) reduction bundle, including cleaning and disinfection. After cleaning and disinfection, we can do an environmental examination to check whether it contains C.difficile or not. Traditional, we did the culture to check but it have to wait 24-48 hours. This method was so slow, so in this study, we try to use the molecular methodology to detect C.difficile. Methods: We collected the specimen after 16 hours when the cleaning and disinfection. Then we used the POCT real-time PCR((POCKIT central C.difficile, GeneReach Biotechnology Corp, Taiwan)) and culture agar to detect whether C.difficile is present or not. In this study, we collected 48 specimens from CDI patients’ environments when they transferred to another space or left. Results: We found all the POCT real-time PCR results were the same compared to the culture results. That’s to say, the POCT real-time PCR can replace the culture method and improve the term around time on the diagnosis of C.diffiicle. Conclusion: The molecular method could replace the traditional culture due to it was quick and precise. Patients can’t wait for the culture result in clinical, especially in the ICU. Once delayed, the mortality rate would arise. In other words, the POCKIT central C.difficile is useful in clinical. It can be used to detect whether C.difficile survives on the surface or not. However, due to the limitation of the sample count, the statistical significance was not complete. So we will collect the sample to finish this study.

Invasive Escherichia coli disease (IED) is associated with high hospitalization and mortality rates, particularly among adults aged ≥60 years. O-antigens are virulence factors required for E. coli survival. To inform EXPEC9V development, a novel glycoconjugate vaccine targeting E. coli O-antigens that is no longer in active clinical development, this retrospective observational study describes O-serotype prevalence among E. coli isolates from IED patients. Eligible patients were identified from medical record databases (9 January 2018–8 November 2019) across 17 tertiary care hospitals in Europe, North America, and Asia. To estimate vaccine serotype coverage of EXPEC9V, E. coli isolates were O-serotyped using whole-genome sequencing and agglutination. Antimicrobial susceptibility testing was also performed. Nine hundred and two patients were enrolled, of whom 690 (76.5%) were aged ≥60 years. Common serotypes were O25, O2, O6, O1, O15, O75, O16, O4, and O18, with O25 being the most reported (17.3%). In patients aged ≥60 years, 422/637 E. coli isolates were EXPEC9V O-serotypes. EXPEC9V O-serotype prevalence did not substantially differ when stratified according to sex, presence of a positive blood culture, sepsis, fatality, or multidrug resistance. Consistent with previous studies, serotype O25 was most prevalent and associated with ~20% of cases. An EXPEC9V vaccine serotype coverage of 66.2% was observed for IED patients aged ≥60 years.

Throughout the history of philosophy, numerous philosophers have formulated theories about the connection between law and freedom. However, few have suggested that freedom and love are inherently connected. According to Hegel, the family and marriage represent the initial tangible manifestation of freedom, embodied in ethical and self-conscious love. This contentious thesis pertains to Hegel’s endorsement of the modern bourgeois family and his assertion regarding a compulsory and heteronormative conception of conjugal love. I analyse Hegel’s family theory in what follows, emphasizing the marital relationship as delineated in Outlines of the Philosophy of Right. I examine the significance and ramifications of his dismissal of the marriage contract to illustrate how this creates a paradox. I propose an alternative interpretation of these passages by emphasizing the relationship between love and law within marital relations. I advocate the importance of law within the family and demonstrate its significance to marriage. I assert that Hegel’s understanding of the family, especially regarding marriage, highlights the tensions present in the complex relationship between the legal aspect of marriage as a contract and the ethical aspect rooted in self-conscious love. To achieve this, I firstly reconstruct Hegel’s conception of the family and explore his understanding of marriage as sexual drive, desire, passion and contract. Secondly, I explore Hegel’s notion of ethical and self-conscious love, examining the relationship between law and love to reveal the paradox of marriage. Third, I discuss Hegel’s views on divorce and marriage settlements to demonstrate why marriage cannot overcome the contract. Finally, I discuss why Hegel’s response to the issues he identifies in the theories of his contemporaries is inadequate and how marriage and conjugal love threaten freedom. My claim is that marriage entails a paradoxical relationship between love and law, which calls into question the suitability of marriage to realize freedom.

Introduction: Crowded Emergency and Trauma Department (ETD) have been associated with adverse patient outcomes and higher mortality rates. Crowding and lack of alcohol-based hand rubs (ABHRs) have been found to correlate with lower compliance to hand hygiene (HH) protocols among healthcare workers (HWs). This project aimed to improve and sustain HH compliance (HHC) among HWs in the ETD by adapting to the World Health Organization (WHO) HH Multimodal Improvement Strategy. Methodology: This is a cross-sectional study in ETD, Sarawak General Hospital, a university-affiliated, public tertiary-care hospital in Malaysia. It spanned 12 months, from Jan 2023 to Jan 2024. The intervention involved installing wall-mounted automated ABHR dispensers at multiple fixed locations in ETD. Pre-, during, and post-12 weeks intervention HHC audit were conducted according WHO’s gold-standard direct observation method. We conducted a sequential trend analysis and compared proportions across these periods using a linear logistic regression model to assess the improvement and sustainability of HHC. Results & Discussion: Mean HHC improved from 66% (383/579) (95% confidence interval [CI], 62.1%-70.0%) in the pre- intervention period to 81% (321/397) (95% CI, 76.6%-84.6%) in the intervention period, and further sustained at 85% (302/352) (95% CI, 81.7%-89.3%) in the post-intervention period (P value<0.05). The positive coefficient of 1.13 in the model, when moving from the pre- to the post-intervention period indicates a positive trend in HH compliance. The availability of adequate wall-mounted automated ABHR dispensers at multiple fixed locations at ETD created easy accessibility of ABHRs for HWs and acted as visual reminders for good HH behavior at the ETD. Conclusions: Having wall-mounted automated ABHR dispensers in various fixed locations proved effective in promoting good HH among HWs in emergency settings. It’s essential to have fixed ABHR dispenser placement in crowded - areas like the ETD to improve and sustain HHC among HWs.

Introduction: Optimising antibiotic prescribing in hospitals through antimicrobial stewardship (AMS) initiatives is essential in addressing the global threat of antimicrobial resistance. Methods: Point prevalence surveys were performed in April 2019 and November 2022 utilizing the Hospital National Antimicrobial Prescribing Survey (NAPS) tool. The study aimed to evaluate the prevalence of antibiotic use among inpatients and monitor antibiotic prescribing quality in 2022 compared to 2019 in a Malaysian teaching hospital as part of AMS core elements. Results: The prevalence of antibiotic use remained relatively stable between 2019 and 2022 (44.1% vs. 42.3%), with no significant change observed. Prescription patterns, including the type of antimicrobials, treatment modalities, and prescriptions per patient, showed insignificant differences between the two surveys. Antibiotics from the World Health Organisation (WHO) Access group constituted up to 47% of prescriptions in 2022, while usage of antibiotics from Watch group decreased from 57% to 53%, albeit insignificantly. Notably, there was a non- significant increase in appropriate prescribing for surgical prophylaxis in 2022 (40% vs 16.7%, p=0.078), alongside a less prevalent in prolonged surgical prophylaxis (28% in 2022 vs. 50% in 2019). Despite static prevalence and prescribing patterns, compliance with guidelines (p<0.006) and appropriate prescribing (p<0.002) showed significant improvement. The likelihood of compliance and appropriate prescribing was approximately 1.8-fold higher in 2022 compared to 2019. However, an increase in prescription of unnecessary broad-spectrum antibiotics was observed (23.1% vs 48%, p=0.002). Multiple logistic regression revealed that inappropriate prescribing significantly occurred when antibiotic indication was poorly documented (adjusted OR 3.67;95% CI 1.28–10.53; p=0.016). Conclusion : While prescribing patterns remained relatively unchanged, our findings highlight notable improvement in antibiotic prescribing quality. However, challenges persist, including the increased use of unnecessary broad-spectrum antibiotics. Continued efforts in AMS are imperative to address these issues and further enhance prescribing practices.

This longitudinal study examined the cognitive development of Spanish children from monolingual backgrounds attending schools with varying levels of English exposure (13%–83%) to assess whether higher L2 exposure results in advantages over time. 229 children (ages 6–7) completed background (nonverbal reasoning (NVR), working memory (WM), L1 vocabulary, L2 vocabulary) and experimental tests measuring attentional/executive functions (selective attention, divided attention, switching, inhibition) at the beginning and end of year 1 of primary education. Generalized linear mixed-effects models, accounting for factors such as family educational level, onset of L2 exposure and language exposure outside of school, indicated that children’s cognitive skills benefit from (high) L2 exposure at school, with greater L2 exposure being linked to more enhanced attentional/executive skills as well as to a larger L2 vocabulary. These findings support the positive effects of immersion programs, suggesting that L2 exposure in school settings alone can contribute to more developed attentional/executive skills.

Objectives: Healthcare-associated respiratory viral infections (HA-RVI) remain a threat despite the fading memory of the pandemic. To better understand the impact of HA-RVI, we reviewed endemic respiratory viral infections in our tertiary academic hospital just before the pandemic. Methods: A retrospective analysis of a hospital epidemiology database with all patients tested positive for respiratory viruses between Jan2016 – Dec2019 was conducted. Testing was ordered by attending physicians and done using immunofluorescence assays or multiplex PCR. HA-RVI patients were identified based on positive virologic tests >48 hours after admission. Data analyses were performed on Vassar Stats. Results: Of the 1700 patients included in this study, 315(18.5%) had HA-RVI while 1385(81.5%) had community-acquired infections (CAI). Influenza, enterovirus/rhinoviruses and respiratory syncytial virus were the most common viruses. Compared with CAI, HA-RVI patients were older (mean age 37.129.7 vs 21.427.5 years, p<0.001), had recent hospitalisations (OR 1.5, 95% CI:1.1-2.1, p=0.007), underlying bronchial asthma or COPD (OR 2.8, 95% CI:1.5-5.3, p=0.002) and were immunosuppressed (OR 7.6, 95% CI:4.3-13.4, p<0.001). Interestingly, HA-RVI patients were less likely to have fever (49.8% vs 66.4%, p<0.001), cough (42.2% vs 67.3%, p<0.001) or shortness of breath (17.5% vs 26.6%, p=0.02). Despite fewer symptoms, HA-RVI patients were more likely to have pneumonia with abnormal chest x-rays (33.3% vs 22.7%, RR 1.14, 95% CI:1.02-1.29, p=0.04), longer lengths of stay (mean 21.236.7 vs 514 days, p<0.001), higher rates of ICU admission (14.9% vs 8.1%, OR 2.0, 95% CI:1.4-2.9, p<0.001), and mortality (4.8% vs 0.6%, OR 8.6, 95% CI:3.6-20.5, p<0.001). Conclusions: Patients who are older, have pre-existing respiratory disorders or are immunosuppressed face greater HA-RVI risk. HA-RVI patients are less likely to exhibit typical respiratory infection symptoms, potentially delaying diagnosis. This probably contributes to increased morbidity and mortality associated with HA-RVI which underscore the importance of hospital infection prevention even for endemic respiratory viruses.

Background: Vietnam has the national guidelines for infection control in hospitals and it also recommends the application of WHO’s IPCAF framework to do self-evaluation of infection prevention and control (IPC) activities and plan to improve them in hospitals. Objective: Our study aimed to implement the multimodal strategy for IPC, in which our expected outcome was the practices of doctors and nurses for pediatric ventilator-associated events (Ped-VAE). Design: We used the implementation research approach with the hybrid design of quasi-experimental pre-post comparison without control group. All 16 doctors and 32 nurses at the Department of PICU were observed 3 times that practicing the IPC packages for PedVAE guided by MOH. The implementation strategies used included Plan, Restructure, Train, and Quality Management. Results: Four over six steps practised by doctors and 5/10 steps practised by nurses for PedVAE were well practised after the intervention with significantly higher proportion of right practices (p<0.001). The practices of doctors had insignificant changes between pre-post intervention, including hand hygiene (85.4% and 83.3% of right practice at pre-post intervention, respectively) and daily assessment of weaning from mechanical ventilation (54.2%-68.7%). Most unchanged practices among nurses were steps of ensuring humidification and heating of inhaled gas for in patients with artificial airway.

All practice scores of the whole steps among doctors and nurses had statistically significant increase after intervention. Our implementation strategies were highly assessed by providers (doctors and nurses) and hospital managers in terms of the its acceptibility, feasibility and sustainability. Conclusion: The implementation of multimodal strategy in IPC for pediatric ventilator-associated events is effective and acceptable and feasible for hospitals at city/province level in Vietnam. In addition with improving practices of healthcare staffs, hospitals should regularly assess and upgrade ventilators machines to ensure the effectiveness of IPC.